The FNCA 2013 Workshop on Radiation Oncology was held from 19 to 22nd November 2013 in Seoul, Korea. The workshop was co-organized by the Korea Institute of Radiological & Medical Sciences (KIRAMS) and the Ministry of Education, Culture, Sports, Science and Technology (MEXT) of Japan. 25 representatives from 11 FNCA Member States, namely Bangladesh, China, Indonesia, Japan, Kazakhstan, Korea, Malaysia, Mongolia, the Philippines, Thailand and Vietnam, and 2 Regional Cooperation Agreement (RCA) Member States-Myanmar and Pakistan as observers participated in the workshop.
This project carries out some international joint clinical studies in order to establish treatment protocols for Uterine Cervix cancer, Nasopharyngeal cancer and Breast Cancer, which affect large numbers of people in FNCA member countries, and finally to improve the technique of radiation oncology in the Asian region.

Prof. Eui Kyu CHIE, Department of Radiation Oncology, Seoul National University Hospital gave a special lecture on "Multi-institutional Cooperative Study Group Clinical Trials: KROG, Efforts of Korean Radiation Oncologists. He spoke about the general concepts and importance of clinical trials, and the activities of Korean Radiation Oncology Group (KROG).

Phase II Study of Concurrent Chemoradiotherapy and Extended-Field Radiotherapy for Locally Advanced Cervical Cancer (CERVIX-IV)
In this protocol, 87 patients are registered from all the countries (at the point of this workshop) and 83 patients are considered evaluable. (However, the total recent clinical data presented by the representatives of each country in this session was 84, which consisted of Bangladesh (24), China (7), Indonesia (6), Japan (19), Korea (7), Malaysia (5), Philippines (4), Thailand (4) and Vietnam (8).)
Clinical results showed comparable toxicity between CERVIX-III and IV, therefore, the treatment protocol of CERVIX IV is acceptable. Loco-regional control is 95.5% at 2 years and 89.3% at 5 years. The overall survival is 89.6% at 2 years and 71.6% at 5 years, which is better than CERVIX- III. For CERVIX-IV, there is a need to collect additional data to complete the study and for publication in the coming years.

New Protocols for Cervical Cancers (CERVIX-V)
Following the discussion and agreement at the last workshop, two new protocols were introduced and discussed.

First, Japan introduced and reviewed "3D image-guided brachytherapy (3D-IGBT)" and presented preliminary report as well. In the report, Japan proposed 3 model cases of cervical cancers and also the treatment regimens using 3D-IGBT for each case with good representation in the variation of tumor size and parametrial invasion.

Next, Japan presented another protocol namely Phase II study of CCRT for locally advanced adenocarcinoma.- With increasing incidence of this histology type of cancer, data collection for a retrospective study on the above was proposed.

For the 3D brachytherapy protocol, both technical feasibilities (infrastructure) and enrollment possibilities (resources of staff, machine and time) were discussed. The data center will send three simulated cases to the participants.
For second protocol of adenocarcinoma of cervical cancer, 60 patients are required. All participants are expected to send the number of adenocarcinoma or adenosquamous carcinoma cases in the last two years to data center. The full protocol will be presented next year by Japan. In the meantime, data center will send the form for retrospective study.

Phase II Study of Chemoradiotherapy for NPC (T3-4, N0-1) (NPC-II)
A total of 70 cases are registered in this protocol. Update on clinical data of NPC-II was presented by representatives of each participating country.( Bangladesh ( 0 ), China( 0 ), Indonesia ( 13 ), Japan( 0 ), Kazakhstan (0), Korea ( 0 ), Malaysia ( 6 ), Mongolia (0), Philippines( 0 ), Thailand ( 1 ), and Vietnam ( 50 ).) This was followed by the open discussion which was mainly about closing the study as the enrollment of new patients for NPC-II was poor over past 3 years. The participants explained their recruitment difficulties. It was mentioned that the data of 70 patients can be published in international journal and it was agreed by the participants to close the NPC -II study.

QA/QC of External Beam Therapy
This activity aims to put in place reliable dosimetry in the institutes among the member countries for effective joint clinical studies. The audits in QA/QC of dosimetry measurement and radiation calibration have been conducted, which is for the reliable radiotherapy of cervical cancers.
A Report on a summary of intercomparison measurements using validated glass dosimeters done on 44 beams in 16 facilities with 4-18 MV at 11 countries were presented by Japan. This fiscal year, measurements were done in Kazakh Institute of Oncology and Radiology, Kazakhstan. Future plan is to do additional audit from host institutions in participating countries.

Korea also spoke on QA/QC for External Beam Radiotherapy and Current Status in Korea.

Phase II Study of Concurrent Chemoradiotherapy (CCRT) for NPC (NPC-III)
A total of 47 patients are registered in this protocol and analyzed at the point of this workshop. (However, the total recent clinical data presented by representatives of each country in this session was 49, which consisted of Bangladesh (1), China (5), Indonesia (7), Japan (0), Kazakhstan (0), Korea (0), Malaysia (9 ), Mongolia (0), Philippines ( 7), Thailand (0) and Vietnam (20).) The toxicities for NPC-III were tolerable when compared with NPC-I. The 2-year and 3-year local control rates for NPC-III was lower than NPC-I. The 2 year and 3 year PFS and OS were similar for NPC I and NPC III.
An open discussion on the clinical data of Phase II study of CCRT for NPC-III followed. The issue of local control due to treatment interruption was discussed. It was also proposed that toxicities between the two studies should be evaluated. In addition, it was proposed that those who are using IMRT can implement this technique for NPC-III patients. Finally, the expected total number of patients for this study is 120.

Phase II Study of Hypofractionated Radiotherapy for Breast Cancer (BREAST-I)
The new protocol BREAST-I which was developed in the last workshop was introduced and reviewed. Revisions were made on the registration form and will be emailed to all soon. The recent clinical data of BREAST-I was presented by representatives of each country. The following numbers were reported: Bangladesh ( 23 ), China ( 2 ), Indonesia (3), Japan (19), Kazakhstan (0), Korea (0 ), Malaysia ( 0 ), Mongolia (1), Philippines (0 ), Thailand (1) and Vietnam ( 0 ). A total number of patients were 49, BCT (27) and PMRT (22)---Discussion on indication of axillary and supraclavicular radiation therapy and possibility of making two separate protocols like BCT & PMRT were also discussed. Supraclavicular RT is permitted.

Country Report from Member Countries and Collaboration of FNCA and IAEA/RCA
Country reports on Current status of radiotherapy facilities and cancer statistics were presented by Dr. Kyawt Kyawt Naing representatives from Myanmar and Ms. Masooma Riaz from Pakistan.
It was followed by new topics from each member county were reported.
China, Indonesia, Japan, Kazakhstan, Mongolia and Vietnam updated the participants on the newer and more modern facilities that will soon be established in their respective countries.
Also, global dissemination about FNCA activities were introduced by some countries.
In addition, Thailand proposed that FNCA should do a mathematical model for predicting clinical outcome for the various cancers that FNCA is currently working on. This proposal was agreed.
Lastly, the training courses on radiation therapy which will be held in member countries were introduced.

Technical Visit
The participants conducted a Technical Visit to KIRAMS. The background and achievements of the hospital were presented. This was followed by a tour of the radiotherapy facilities including Cyber-knife Center of the hospital.
The participants also visited the Proton Therapy Center of National Cancer Center.

Future Plans & Evaluation of the last 3 years' activities
It was agreed that the next workshop will be held in Vietnam tentatively on the last week of November, 2014.
It was also unanimously agreed in the meetings that the venue of FNCA meeting after 2014 can be held in other countries like Mongolia and Kazakhstan, upon official approval.
It was emphasized that the same participants should attend the annual FNCA meeting to present their clinical data. This will ensure continuity and success of the protocol studies.
Dr. Kumiko Karasawa suggested working together with the local radiation oncology society on FNCA activities.

Closing Session
The workshop was officially closed by Dr. Karasawa's remark. She expressed her appreciation to Korea as well as all the participants for their contribution and her expectations for the future of the project.

Open Lectures
Lectures open to the public was held at KIRAMS as a part of the workshop. There were 6 lectures on the themes of 1) Introduction of FNCA Radiation Oncology Project. 2) Present Status of Radiation Oncology in Korea, 3) Concurrent Chemoradiation for Head and Neck Squamous Cell Carcinomas, 4) Intensity Modulated Radiotherapy (IMRT), 5) Breast Cancer and 6) Particle Beam.

Minutes of
FNCA FY2013 Workshop on Radiation Oncology Project

November 19-22, 2013
Seoul, Korea

(1) Following the agreement of Forum for Nuclear Cooperation in Asia (FNCA) /the 14th FNCA Coordinators Meeting, the FNCA FY2013 workshop on Radiation Oncology was held from November 19th to 22nd, 2013, in Seoul, Korea. The meeting was co-organized by the Korea Institute of Radiological & Medical Sciences (KIRAMS) and the Ministry of Education, Culture, Sports, Science and Technology (MEXT) of Japan. Representatives from 11 FNCA Member States, namely Bangladesh, China, Indonesia, Japan, Kazakhstan, Korea, Malaysia, Mongolia, the Philippines, Thailand and Vietnam and 2 Regional Cooperation Agreement (RCA) Member States - Myanmar and Pakistan as observers from the International Atomic Energy Agency (IAEA) participated in the meeting.

(3) Prof. Eui Kyu CHIE, Department of Radiation Oncology, Seoul National University Hospital gave a special lecture on "Multi-institutional Cooperative Study Group Clinical Trials: KROG, Efforts of Korean Radiation Oncologists. He spoke about the general concepts and importance of clinical trials, and the activities of Korean Radiation Oncology Group (KROG).

(4) Introduction of individual participants followed.

(5) The agenda was adopted, and chairpersons and reporters were elected. (See Annex 1)

(6) Dr. Masaru Wakatsuki, Medical Doctor of Research Center Hospital for Charged Particle Therapy, National Institute of Radiological Sciences (NIRS) introduced the protocol of Cervix IV. The summary of the follow-up data was also presented by him. 87 cases were registered in this protocol. The follow-up rate at the point of this workshop was 99% (86/87cases).
Update of clinical data of Phase II Study of Concurrent Chemoradiotherapy and Extended-Field Radiotherapy for Locally Advanced Cervical Cancer (CERVIX-IV) was presented by representatives of each participating country with the following number of patients: Bangladesh (24), China (7), Indonesia (6), Japan (19), Korea (7), Malaysia (5), Philippines (4) Thailand (4) and Viet Nam (8)
Dr. Wakatsuki presented the summary of the clinical data. There are 87 patients registered this protocol and 83 patients were evaluated. Clinical results showed comparable toxicity between CERVIX-III and IV, therefore, the treatment protocol of CERVIX IV is acceptable. Loco-regional control is 95.5% at 2 years and 89.3% at 5 years. The overall survival is 89.6% at 2 years and 71.6% at 5 years, which is better than CERVIX- III

(7) An open discussion on the clinical data of Cervix-IV followed. For CERVIX-IV there is a need to collect additional data to complete the study and for publication in the coming years.

Session 2: New Protocols for Cervical Cancers (CERVIX-V)

(8)Following the discussion and agreement at the last workshop, two new protocols were introduced and discussed.

(9) First, Prof. Shingo Kato, Professor of the Department of Radiation Oncology, International Medical Center, Saitama Medical University introduced and reviewed "3D image-guided brachytherapy (3D-IGBT)". Next, Dr. Masaru Wakatsuki presented a preliminary report. In the report, he proposed 3 model cases of cervical cancers and also the treatment regimens using 3D-IGBT for each case with good representation in the variation of tumor size and parametrial invasion.

(10) Dr. Masaru Wakatsuki presented another protocol namely Phase II study of CCRT for locally advanced adenocarcinoma.- With increasing incidence of this histology type of cancer, he proposed data collection for a retrospective study on the above.

(11) An open discussion on the two new protocols followed.
For the 3D brachytherapy protocol, both technical feasibilities (infrastructure) and enrollment possibilities (resources of staff, machine and time) were discussed. The data center will send three simulated cases to the participants.

For second protocol of adenocarcinoma of cervical cancer, 60 patients are required. All participants are expected to send the number of adenocarcinoma or adenosquamous carcinoma cases in the last two years to data center. The full protocol will be presented next year by Dr. Wakatsuki. In the meantime, data center will send the form for retrospective study.

(13) An open discussion on the clinical data of NPC (T3-4, N0-1) (NPC-II) followed. The main discussion was about closing the study as the enrollment of new patients for NPC-II was poor over past 3 years. The participants explained their recruitment difficulties. Dr. Ohno mentioned the data of 70 patients can be published in international journal and it was agreed by the participants to close the NPC -II study.

Session 4: QA/QC of External Beam Therapy
(14) Report on a summary of intercomparison measurements using validated glass dosimeters done on 44 beams in 16 facilities with 4-18 MV at 11 countries were presented by Dr. Shigekazu Fukuda, Head of Heavy Particle Faculty Section, Dept. of Accelerator and Medical Physics, Research Center for Charged Particle Therapy, NIRS. This fiscal year, measurements were done in Kazakh Institute of Oncology and Radiology, Kazakhstan. Future plan is to do additional audit from host institutions in participating countries.

Session 5: Phase II Study of Concurrent Chemoradiotherapy (CCRT) for NPC (NPC-III)
(16) Prof. Tatsuya Ohno introduced the protocol NPC-III. The recent clinical data of Phase II Study of CCRT for NPC (NPC-III) was presented by representatives of each participating country. The following numbers were reported: Bangladesh (1), China ( 5 ), Indonesia ( 7 ), Japan (0), Kazakhstan (0), Korea (0), Malaysia (9 ), Mongolia (0), Philippines ( 7), Thailand (0) and Vietnam (20). Prof. Tatsuya Ohno presented the summary of the clinical data and the evaluation of the NPC-III study results. 47 patients of NPC-III were analyzed. The toxicities for NPC-III were tolerable when compared with NPC-I. The 2-year and 3-year local control rates for NPC-III was lower than NPC-I. The 2 year and 3 year PFS and OS were similar for NPC I and NPC III.

(17) An open discussion on the clinical data of Phase II study of CCRT for NPC-III followed. The issue of local control due to treatment interruption was discussed. It was also proposed that toxicities between the two studies should be evaluated. In addition, Prof. Ohno proposed that those who are using IMRT can implement this technique for NPC-III patients. Finally, the expected total number of patients for this study is 120.

Session 6: Phase II Study of Hypofractionated Radiotherapy for Breast Cancer (BREAST-I)
(18) Dr. Kumiko Karasawa Head of Treatment Team3 , Research Center Hospital for Charged Particle Therapy, National Institute of Radiological Sciences (NIRS) introduced and reviewed the protocol BREAST-I which was developed in the last workshop. Revisions were made on the registration form and will be emailed to all soon. The recent clinical data of Phase II Study of Hypofractionated Radiotherapy for Breast Cancer (BREAST-I) was presented by representatives of each participating country. The following numbers were reported: Bangladesh ( 23 ), China ( 2 ), Indonesia (3), Japan (19), Kazakhstan (0), Korea (0 ), Malaysia ( 0 ), Mongolia (1), Philippines (0 ), Thailand (1) and Vietnam ( 0 ). Total number of patients were 49, BCT (27) and PMRT (22)---Discussion on indication of axillary and supraclavicular radiation therapy and possibility of making two separate protocols like BCT & PMRT were also discussed.
Dr. Kumiko Karasawa -presented the summary of the clinical data. Supraclavicular RT is permitted.

(19) Dr. Shigekazu Fukuda Head of Heavy Particle Faculty Section, Dept. of Accelerator and Medical Physics, Research Center for Charged Particle Therapy, NIRS reported on dosimetry in the process of the treatment of the protocol. The use of gown/towel to cover the treatment area is not permitted.

(21) An open discussion on the clinical data of Phase II study of Hypofractionated Radiotherapy for Breast Cancer followed.

Session7 :Country Report from Member Countries and Collaboration of FNCA and IAEA/RCA

(22) Country reports on Current status of radiotherapy facilities and cancer statistics were presented by Dr. Kyawt Kyawt Naing representatives from Myanmar and Ms. Masooma Riaz from Pakistan.

(23)Following the country reports, new topics from each member county were reported.

China, Indonesia, Japan, Kazakhstan, Mongolia and Vietnam updated the participants on the newer and more modern facilities that will soon be established in their respective countries.

Global dissemination about FNCA activities:

1. The book titled "Carbon Ion Radiotherapy" written by Dr. H. Tsujii will be published soon.

2. The FNCA activities in radiation oncology was reported by Dr. K. Karasawa in "29 Congress of International Medical Women's Association held in Korea, August, 2013.

3. The FNCA cervix cancer data was presented by Dr. M. Calaguas at the 55th ASTRO Annual meeting held in Atlanta, USA, on 25th September 2013.

Proposed new topic:
Dr. Kullathorn Thephamongkhol proposed that he would like to do a mathematical model for predicting clinical outcome for the various cancers that FNCA is currently working on. Dr.Tsujii suggested that he should provide the proposal. All participants agreed.

Session 8: Technical Visit at Korea Institute of Radiological &Medical Sciences (KIRAMS)
(24) The participants conducted a Technical Visit to KIRAMS. Dr. Kwon-Soo Chun, Principal Researcher, Radiopharmaceuticals Production Center, welcomed the group and presented the background and achievements of the hospital. This was followed by a tour of the radiotherapy facilities including Cyber-knife Center of the hospital.

Session 9: Technical Visit at National Cancer Center -Korea
(25) The participants conducted a Technical Visit to the National Cancer Center of Korea. They visited the Proton Therapy Center.

(26) Regarding Next Workshop, Schedule of the Next Workshop and Other activities, the following items were discussed and agreed.

1. All participants unanimously agreed that the same participants should attend the annual FNCA meeting to present their clinical data. This will ensure continuity and success of the protocol studies.

2. Dr. Karasawa suggested working together with the local radiation oncology society on FNCA activities.

3. It was agreed that the next workshop will be held in Vietnam, tentatively on the last week of November, 2014.

4. It was unanimously agreed in the meetings that the venue of FNCA meeting after 2014 can be held in other countries like Mongolia and Kazakhstan, upon official approval.

Session 11: Drafting the Workshop Minutes
(27) The draft minutes presented by reporters were discussed and amended.
The minutes were unanimously adopted by the workshop participants.

Closing Session
(28) Dr. Kumiko Karasawa closed the workshop officially with her closing remark, in which she expressed her appreciation to Korea as well as all the participants for their contribution and her expectations for the future of the project.

Session 12: Open Lectures
(29) Open lecture to the public was held at KIRAMS as a part of the workshop. In Opening Ceremony, Dr. Chang Woon Choi, Director General, Research Institute of Radiological & Medical Sciences, KIRAMS gave a welcome remark. Dr. Mi-Sook Kim, Chief, Department of Radiation Oncology, KIRAMS moderated the session.

(30) As the first lecturer, Prof. Shingo Kato from Saitama Medical University spoke on Introduction of FNCA Radiation Oncology Project.

(31)On the theme of Present Status of Radiation Oncology in Korea, Dr. Mi-Sook KIM from KIRAMS gave a lecture.

(32) Dr. Dang Huy Quoc Thinh from Ho Chi Minh City Oncology Hospital gave a lecture on Concurrent Chemoradiation for Head and Neck Squamous Cell Carcinomas.

(33) Dr. Miriam Joy Calaguas from St.Luke's Medical Center gave a lecture on Experiences in IMRT.

(34) Dr. Kumiko Karasawa from NIRS spoke on Breast Cancer

(35) Dr. Won Gyun Jung from KIRAMS gave a lecture on the theme of Particle Beam.

(36) Dr. Kumiko Karasawa from NIRS concluded the Open Lecture with her closing remarks.

Agenda of
FNCA FY2013 Workshop on Radiation Oncology Project

November 19-22, 2013
Seoul, Korea

Day 1Tue, 19 November 2013 Place : Korea Institute of Radiological &Medical Sciences(KIRAMS)